Wednesday, June 6, 2018

Dax, France -- a Prototype Village for Residents with Dementia?

From Ben Mulford, a law graduate working at the Iowa Department on Aging, comes an interesting description of a French village designed to give residents who have Alzheimer's Disease as much freedom and normalcy of life as possible, in a safe setting. Map Dax France

Work has begun on France's first "Alzheimer's village” where patients will be given free rein without medication in a purpose-built medieval-style citadel designed to increase their freedom and reduce anxiety. 

 

Residents of the village in Dax, southwestern France, will be able to shop in a small supermarket, go to the hairdressers, local brasserie, library, gym and even a little farm.  They will live in small shared houses designed to reflect their personal tastes and in four districts reminiscent of the southwestern French region between forests and the seashore.

 

While it may sound similar to a typical residential complex, the inhabitants are all men and women suffering from Alzheimer's,  the commonest cause of dementia. . . . 

 

The village is the brainchild of the late Henri Emmanuelli, a former Socialist minister and local MP who launched the project after reading about a Dutch gated model village in Weesp, Netherlands, seen as a pioneering care facility for elderly people with dementia.

 

Residents are confined to the village for their own safety but are allowed to move around freely inside and are watched over by plain-clothed medical staff. The staff don't treat patients, they care for residents, they say.
 
Interesting details include the plans for researchers "cohabiting" with residents, and using a high ratio of live-in carers and volunteers to stage activities.   The article makes the amusing (worrying?) comparison to the plot of The Truman Show, a movie where a key resident, played by Jim Carrey, was living in a fake town.    
 
Will this be cost effective?   The projection is described as "largely funded by the region," and the prediction is it will "only cost patients €66 per day, roughly the same as the rate for a traditional nursing home in France."  
 
I'm a bit skeptical about the "medieval" citadel design as being comforting.  I doubt if residents would be that old.  But, perhaps it would enhance a vacation feel to the location.  I know a resident of a dementia care community, one that follows a village concept on a smaller scale, and when the misting system is operating to cool the exterior porches for all the cottages, she thinks she's at a hotel on the coast of California.  That is a nice alternative to reality -- Arizona in the summertime.  Plus, ambiance of the location is important to attracting and keeping workers, and to make family members and friends feel relaxed and welcome, too.
 
Thank you, Ben, for sharing this interesting piece.  For more, read France Starts Work on Revolutionary 'Alzheimer's Village' Where Patients Roam Almost Free, from The Telegraph

June 6, 2018 in Cognitive Impairment, Consumer Information, Dementia/Alzheimer’s, Health Care/Long Term Care, Housing, International | Permalink | Comments (0)

Tuesday, June 5, 2018

Thank you Professor Frolik

Professor Larry Frolik is a rock star, plain and simple. If you ask anyone about the development of elder law, especially in law schools, Professor Frolik's is the first name coming to mind. His contributions to the field are immense and so important.  I was saddened to learn in the spring semester that he was retiring at the end of said semester. Serious bummer. But, good news arrived in the form of an email from him late last week. Although he's retired, he reported that he will keep his office at the College of Law at U. Pitt and also his email address. I suspect he'll continue to be involved in the field and for that possibility, I am extremely grateful. Join me by sending Professor Emeritus Frolik an email thanking him for all of his guidance, leadership and contributions to getting the field,and all of us academics, to where we are today!  Thank you Professor Frolik!!!

June 5, 2018 in Consumer Information, Current Affairs, Other | Permalink | Comments (0)

Humor and Commitment: Hallmarks of Professor Emeritus Lawrence Frolik

I join my blogging colleague Rebecca Morgan in paying tribute to Professor Lawrence -- no, make that Larry -- Frolik as he takes emeritus status at the University of Pittsburgh School of Law.  Professor Frolik was one of the first people who impressed upon me that elder law was a true field unto itself. We celebrate his faith in developing high standards for practice in representation of older clients, including his work with the National Academy of Elder Law Attorneys (NAELA) and the AALS Section on Aging and the Law.  

His publications are legion and his research, writing and teaching go far beyond aging, as he is an expert on tax law, disability law, torts, and more.   

In addition to appreciation of his commitment to education, one of my strongest impressions of Larry is of his ability to use humor to brighten one's day.  The American Bar Association Bar Journal, seeking stories from law students about "the best law professor you ever had," captured this well with one student's response:

"Lawrence Frolik at Pitt Law. Torts, fall semester 1L. He was absolutely terrifying, but it was clear from the get-go that he was a master of the socratic method. So much so that, as long as you weren’t called on, it was great theater. He mixed great wit and insight with teaching. A friend even dressed up as him for Halloween."

I also chuckle in remembering my very first AALS dinner out, following a section meeting, in San Francisco.  I learned then to always carry some extra cash when dining -- and splitting the bill -- with Larry. He has great taste and it was a fun night for all, led by Larry's appreciation for fun and  good humor.  

All good wishes to you, Professor Frolik. I'm sure you are not truly retiring, just finding a different way to inspire us all.  

June 5, 2018 | Permalink | Comments (0)

Monday, June 4, 2018

More on California's Aid-in-Dying Law

As we previously blogged, after a trial court judge struck the law, the California Attorney General filed an appeal.  According to a recent article in the San Francisco Chronicle, California’s right-to-die law on hold for at least a month.

California’s right-to-die law for terminally ill patients will apparently remain suspended for at least another month after a judge on Wednesday reaffirmed his ruling that the law was illegally considered and passed during a special legislative session on health care.

[The judge] ruled the law invalid May 15 and halted its enforcement last Friday. It had been in effect since June 2016, allowing doctors to prescribe life-ending medication to mentally competent adults who have less than six months to live.

On Wednesday, the nonprofit Compassion & Choices ... asked [the judge] to suspend his ruling and cited its potential impact on two terminally ill patients, one of them an 82-year-old Marin County woman who has already obtained a prescription for life-ending medication. The judge denied the request.

The state attorney general also weighed in, seeking to have the order set asid eon the grounds that "the judge improperly issued a statewide order in a local lawsuit and also should have given his office 10 days, under state law, to file objections to Friday’s order before putting it into effect."  The Judge has set a June 29 hearing.

The article offers this to describe the impact of the order. "Because of the ruling, doctors can no longer prescribe life-ending medication to dying patients, and a patient who had already been provided with the medication would be committing suicide by taking it, with implications for insurance coverage." 

Stay tuned!

June 4, 2018 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Ghost Children and the Risks of Eviction

There have been sad stories covering the legal proceedings in New  York of one couple's recent attempts to evict their 30 year old son from their home.  We occasionally had similar matters in the Elder Protection Clinic at Dickinson Law.  We even had a name for the situation -- "ghost children," as typically the adult child was living in one room, rarely interacting with the rest of the family and often entering or leaving when the parents were away to avoid communications.  The older parents would implore us to "do something," but often they did not want to file formal eviction proceedings.  Letters requesting departure and offering mediation sometimes worked, but more often did not.  

I suspect that if you had been following the proceedings of the New York parents, you were worried about the outcome, as the son seemed to be digging in and pulling out all the stops to resist eviction.  I know I worried when I first saw a new headline, reporting that a man had killed his elderly parents and then himself, rather than quietly depart.  Tragically, that was a "second" case, in Illinois, not New York. 

No easy answers here.  The problems are a long time in the making.  

June 4, 2018 in Crimes, Ethical Issues, Housing, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Friday, June 1, 2018

2018 World Elder Abuse Awareness Day Webinar

Happy June 1. Celebrate by registering now for a free webinar for World Elder Abuse Awareness Day! From the DOJ Elder Justice Initiative, this 4 p.m. webinar will include:

A presenter from the Social Security Administration will share the latest on representative payees; an EJI representative will talk about the Elder Abuse Prevention and Prosecution Act and new resources being developed to better respond to elder abuse; an expert from the Administration for Community Living will describe their guardianship grant programs and the importance of data collection for policy and programmatic enhancement; and the Deputy Director of the National Center on Elder Abuse will present on some of the latest trends and resources that will help you to better respond to elder abuse.

Expert presenters include:
Lydia Chevere, Public Affairs Specialist, Social Security Administration
Aiesha Gurley, Aging Specialist, Office of Elder Justice and Adult Protective Services, U.S. Department of Health and Human Services
Susan C. Lynch, Senior Counsel for Elder Justice, U.S. Department of Justice
Julie Schoen, Deputy Director, National Center on Elder Abuse

To register for this webinar, click here

June 1, 2018 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, International, Programs/CLEs, Webinars | Permalink | Comments (0)

Wednesday, May 30, 2018

Details Emerge on the Federal Senior $afe Act

I promised more information about the consumer protection measures signed into law by President Trump on May 24, 2018.  Here's the more detailed update I wrote for WealthManagement.com:  The New Senior $afe Act Encourages Reporting Senior Financial Abuse. 

May 30, 2018 in Consumer Information, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Federal Statutes/Regulations, Property Management | Permalink | Comments (0)

Tuesday, May 29, 2018

Register Now: Free Webinar on Helping Elders Post-Disaster

With hurricane season looming (it starts June 1), this notice about an upcoming webinar is particulary timely. The National Center on Law & Elder Rights has scheduled a free webinar for June 20, 2018 at 2 p.m. edt, Assisting Older Homeowners After a Natural Disaster. The announcement explains this about the webinar

Older adults face unique challenges and exhibit different vulnerabilities during and after a natural disaster. Older homeowners, for example, may need additional assistance securing their homes and moving out of a storm's path. Recovering from the disaster may also be a challenge for older adults on fixed or limited income. This free webcast will address both the practical challenges and resources available to aid older homeowners after a disaster. The discussion will highlight the loss mitigation and other options available to prevent mortgage foreclosure, and housing and other related assistance from FEMA. Closed captioning will be available on this webcast. A link with access to the captions will be shared through GoToWebinar’s chat box shortly before the webcast start time. Presenters: • Odette Williamson, Staff Attorney, National Consumer Law Center • Sapna Aiyer, Managing Attorney, Housing & Consumer Unit, Lone Star Legal Aid

May 29, 2018 in Consumer Information, Current Affairs, Federal Cases, Federal Statutes/Regulations, Housing, Other | Permalink | Comments (0)

No Stay During Appeal of California Aid-in-Dying Law

As we reported last week, a trial court judge in California held that the California physician-aid-in-dying law was invalid.  The state appealed, according to an article in the LA Times.  A subsequent article in the New York Times reports that the appellate court declined a stay of the trial court's ruling pending the appeal,  No Stay of Ruling That Tossed California Assisted-Death Law.  "California's 4th District Court of Appeal refused to grant an immediate stay requested by state Attorney General Xavier Becerra. However, the court gave Becerra and other parties time to "show cause" — that is, provide more arguments as to why the court should grant the stay and suspend the lower court ruling.” Since no injunction was entered, the law still is in effect, as noted in the article. The California AG " argued that the measure was legitimately passed and asked [the appellate court] for quick action so that terminally ill people seeking options under the law wouldn't die "an excruciating, painful death" before the issue is finally decided."

Stay tuned.

May 29, 2018 in Advance Directives/End-of-Life, Consumer Information, Current Affairs, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Beware the Befriender - Another Tale, This Time from Brooklyn

A book I co-authored on The Law of Financial Abuse and Exploitation was inspired, sadly, by several cases we had in our Elder Protection Clinic at Dickinson Law in Carlisle Pennsylvania.

In one case, at first the relationship between great niece and great aunt had seemed to friends and neighbors to be loving and protective.  It wasn't until the elder's care needs increased, and it turned out there was no money to pay for care by professionals, that the truth was uncovered.  The aunt's money, close to a million over three years, was gone. 

With the benefit of hindsight, you could see how the exploitation began -- with the younger woman asking for permission to use the elder's accounts for a few improvements and upgrades around the house. Then she stopped asking for permission.  Eventually her spending was for fur coats, jewelry and a luxury car (actually, two). Her aunt no longer could see to review her accounts and there weren't any other relatives to ask questions.  The niece probably didn't count on her aunt living past 100 -- or testifying against her at the criminal trial about the unauthorized spending, when she was 101.   The younger woman tried to justify her behavior, testifying at trial that "she wanted me to have the money. She was going to leave it to me in her will."

Several friends, including Karen Miller, in Florida, sent me copies of another tragic tale, this time from Brooklyn via the New York Times.   I suspect, that in this account of a relationship between an older widow and a local waitress, the younger woman probably told herself her "friend"wanted her to have the money.  She too will be thinking about this in jail.  Read She Found Comfort in a Brooklyn Diner, Then Lost Everything.   

May 29, 2018 in Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Ethical Issues, Health Care/Long Term Care, Property Management, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Monday, May 28, 2018

Chip Chiplin 2018 Recipient of NAELA Theresa Award

One of my heroes, Alfred "Chip" Chiplin, who died last year, was the 2018 recipient of the NAELA Theresa Award. The award is presented by the Theresa Foundation and was awarded at the 24th Annual Theresa awards as well as at NAELA's 2018 annual meeting.  The award "is an annual community service award presented by the Theresa Alessandra Russo Foundation to a NAELA member in recognition of his or her advocacy and support of individuals with disabilities."  The award was accepted by Chip's sister.

More information about the amazing work of the Theresa Foundation is available here.

May 28, 2018 in Consumer Information, Current Affairs, Other, Programs/CLEs | Permalink | Comments (0)

NYT: Safety Issues When Guns Are In Elderly Hands

Here's a challenging but potentially important topic for many families on this holiday weekend. 

Becky has a post last week about the importance of doctors asking older patients about guns as a safety risk.  I've posted in the past, here and here,  about related issues, including laws affecting registration of gun ownership when intervivos or testamentary trusts are used as the legal vehicle to pass down weapons to succeeding generations.  

The New York Times continues the conversation with In Elderly Hands, Firearms Can Be Even Deadlier.  From Paula Span's article: 

While older adults make many fewer suicide attempts than younger cohorts, they die more often, in part because they use such lethal methods. Yet health care providers who ask older patients about driving and wandering may not ask about guns.

 

“Safety planning for adults with dementia is something every clinician thinks about, but I don’t think firearms are often on the radar,” said Dr. Donovan Maust, a psychiatrist at the University of Michigan Medical School and co-author of a recent article on guns and dementia in the Annals of Internal Medicine.

 

They should be. At various stages of dementia, people may grow unable to distinguish loved ones from intruders. Their decision-making ability deteriorates. They can become paranoid, depressed, impulsive, agitated or aggressive.

Dr. Maust's co-authored commentary, linked above, is worthy of closer reading.  Perhaps in an attempt to allay the fears of gun owners that dementia is not an automatic disqualifier for gun ownership, the piece suggests that doctors consider the stage of any neurocognitive impairment as part of a multi-party discussion about access:

A diagnosis of cognitive impairment or dementia does not in itself mean that a person should not have access to firearms—the level of cognitive impairment is probably most important. In a recent review, Patel and colleagues proposed using the clinical dementia rating scale to estimate the stage of dementia and the person's ability to safely complete complex tasks, including firearm handling. 

 

For patients with minimal cognitive impairment, approaches could be similar to those related to driving, including acknowledging the emotions involved and allowing the PWD [person with dementia]  to maintain agency in the decision for as long as it is safe. As with an “advance driving directive”, PWDs, their family members, and their health care providers may proactively discuss firearm access and consider setting a “firearm retirement date”. This patient-centered approach may allow an older adult to maintain decisional control and identify trusted family members or providers as future surrogate decision makers. To our knowledge, no one has tested the acceptability or efficacy of this approach.
Did you catch that acronym above, perhaps a new one for many of us?  PWDs? My thanks to colleague Laurel Terry for her early morning reading habits -- and  for sharing the NYT article with us. 

May 28, 2018 in Advance Directives/End-of-Life, Cognitive Impairment, Consumer Information, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Health Care/Long Term Care, Property Management, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Friday, May 25, 2018

Sci Fi Friday: Recommending Short Story "Today I Am Paul"

Of course, I'm supposed to be finishing my exam grading.  Instead, while stopping by my office, I find a copy of a short story from one of my colleagues.  The accompanying note says,"Not even my sci-fi 'escape' is untouched by elder care issues.  Thought you'd get a kick out of this."

And indeed, I do.  I definitely recommend "Today I Am Paul," by Martin L. Shoemaker.  The author draws upon his personal experiences in visiting his mother-in-law in a nursing home to craft a true tale ... with a difference ... as the narrating caregiver is an android.  

While my printed-page-loving self recommends reading the short story, I also found a great podcast of the story being read aloud by Kate Baker and I'm linking it here, from Clarkesworld Magazine.  

I now plan to use this story to introduce my Elder Law course in the autumn.  So much to talk about, including the roles of family, caregivers, technology, fear.....   I suspect my co-blogger Becky Morgan, with her often expressed enthusiasm for tech including driverless cars, will appreciate this story too.  Happy reading or listening for Memorial Day weekend!

Many thanks to Dickinson Law Professor Matthew Lawrence for this unique, caring experience.  

May 25, 2018 in Books, Cognitive Impairment, Current Affairs, Dementia/Alzheimer’s, Ethical Issues, Health Care/Long Term Care, Science, Web/Tech | Permalink | Comments (0)

Thursday, May 24, 2018

Not Everyone Is Driving Along the Information Highway

Believe it or not, there are those in the US who are not on the Internet. Although the numbers are growing, some still haven't gotten onto the information highway. We are seeing an increase in the use of the Internet by those we consider elders, but there are still others who don't use it.

Pew Research periodically releases a report on internet use. The last one, a Fact Tank from a couple of months ago, showed a gradual increase.  11% of Americans don’t use the internet. Who are they?explains that "[t]he size of this group has changed little over the past three years, despite ongoing government and social service programs to encourage internet adoption in underserved areas. But that 11% figure is substantially lower than in 2000, when the Center first began to study the social impact of technology. That year, nearly half (48%) of American adults did not use the internet."

The report looks at all age groups, but since this is the elderlawprof blog, I'm interested in the internet usage by elders. The report gives us that:  "[s]eniors are the age group most likely to say they never go online. Although the share of non-internet users ages 65 and older decreased by 7 percentage points since 2016, about a third today do not use the internet, compared with only 2% of 18- to 29-year-olds."

So basically one-third of elders still are off the information highway.  As more and more Boomers move past age 65, it will be interesting to see if that number drops or holds steady.  Our students need to understand that figure, too, since so many of them are online non-stop. 

May 24, 2018 in Consumer Information, Current Affairs, Other, Statistics, Web/Tech | Permalink | Comments (0)

Banking Industry and the New Senior Safe Act

The "Senior Safe Act," part of a federal banking reform law that will modify Dodd-Frank, has been passed by both houses of Congress with bi-partisan support.  Note the sometimes clever spelling for "Safe" as "$afe," used by proponents.  From a McKnight's Senior Living report on  May 23, 2018:

A bipartisan bill intended to help protect older adults from financial exploitation and fraud is on its way to the president's desk to be signed into law.

 

The Senior $afe Act, authored by U.S. Sens. Susan Collins (R-ME) and Claire McCaskill (D-MO), passed in the House of Representatives on Tuesday as part of a bipartisan banking reform package after previously being passed by the Senate in March. President Trump tweeted on Wednesday that he plans to sign the legislation into law.

 

Collins and McCaskill had introduced the Senior $afe Act in 2017 when they were chairman and ranking member, respectively, of the Senate Special Committee on Aging. Collins still leads the committee, and McCaskill remains a member.

 

The legislation protects banks, credit unions, investment advisers, broker-dealers, insurance companies and insurance agencies from being sued for reporting suspected exploitation or fraud as long as they have trained their employees about how to identify the warning signs of common scams and make reports in good faith to the proper authorities.

 

“The Senior $afe Act, based on Maine's innovative program, will empower and encourage our financial service representatives to identify warning signs of common scams and help prevent seniors from becoming victims,” Collins said in a statement.

 I'll report more once I have a close look at the language, as enacted.  

May 24, 2018 in Consumer Information, Crimes, Current Affairs, Elder Abuse/Guardianship/Conservatorship, Estates and Trusts, Ethical Issues, Federal Statutes/Regulations, Statistics | Permalink | Comments (0)

Wednesday, May 23, 2018

Myths & Mistakes About New Medicare Cards: AARP Research Survey

As we all know, CMS has been rolling out the new Medicare cards without SSN on them.  AARP Research conducted a survey about the new cards, and the results are quite interesting.  2018 AARP Survey: Experience and Knowledge of Medicare Card Scams explains:

n March 2018, AARP engaged Alan Newman Research to conduct a national research study among U.S. adults ages 65 and older about their experience and knowledge around the new Medicare cards being issued in April 2018 and potential vulnerability to scams related to the new card and benefits. 

Key findings include the following:

  • Most (76%) U.S. adults ages 65 and older indicate they have not seen, read, or heard much or anything at all about the new Medicare cards (or are not sure).
  • Three in four (75%) Medicare beneficiaries are not sure or are incorrect about the key change with the new cards being new identification number.
  • Nearly two-thirds (63%) of Medicare beneficiaries are unsure or are incorrect in believing that Medicare will charge new beneficiaries a $25 processing fee for the new card. 
  • Over half (56%) are not sure or are wrong in thinking that Medicare will call them to verify their Social Security number before they can receive their new card.
  • At least one in three are extremely/very concerned about being a target of Medicare scam (33%) or victim of identity theft (40%).

A pdf of the survey results is available here.

 

May 23, 2018 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Medicare, Statistics | Permalink | Comments (0)

California AG Files Appeal in From Court Decision Setting Aside Physician-Aided Death Law

Both Becky and I have written about a California trial court's recent ruling that a California's law permitting physician assistance in death was enacted in an unconstitutional manner.  The judge granted a window of five days before the ruling would become effective, to permit any appeal. That appeal has now been filed by the California Attorney General.  From the Los Angeles Times:  

California Atty. Gen. Xavier Becerra on Monday filed an appeal against a judge's recent ruling overturning the state's physician-assisted suicide law. . . . 

 

Becerra's action Monday moves the case to an appeals court, which will decide the future of the law. He also asked that the law stay in place while the matter is further litigated, a request that will most likely be granted, said Kathryn Tucker, an attorney who heads the End of Life Liberty Project at UCSF/UC Hastings Consortium on Law, Science & Health Policy.

As Becky says, stay tuned.  But probably best not to hold your breath while awaiting the next ruling. 

May 23, 2018 in Advance Directives/End-of-Life, Current Affairs, Ethical Issues, Health Care/Long Term Care, State Cases, State Statutes/Regulations | Permalink | Comments (0)

Call for Proposals: American Society on Aging 2019 Annual Conference

The American Society on Aging (ASA) has announced its call for proposals for the 2019 AiA conference, to be held April 15-18, 2019 in New Orleans.  Here's a bit of info about the conference

The 2019 conference will have a strong focus on critical and emergent topics facing the field of aging, as well as cutting-edge and responsive programmatic, research, policy and advocacy efforts. Potential interest areas include: emergency/disaster readiness, housing and transportation access, caregiving, substance use/opioid crisis, multiple aspects of dementia, technology and aging, intergenerational models, population health, and shifting policy and legislative issues affecting older adults. Additionally, we welcome proposals spanning the theme of aging that offer innovative policies, programs, practices, models, businesses and learning. 

To learn more, click here. To submit a proposal, click here. Due date for proposals is June 30, 2018.

May 23, 2018 in Consumer Information, Current Affairs, Other, Programs/CLEs | Permalink | Comments (0)

A Closer Look at Continuing Care at Home Contracts (Sometimes Known as Continuing Care Without Walls)

As I prepare for some summer writing and speaking projects, I've been taking a closer look at Continuing Care at Home (CCaH), sometimes also called Continuing Care Without Walls.  Pennsylvania was among the early states to license CCaH providers, doing so under the Pennsylvania Department of Insurance's regulatory authority for Continuing Care Retirement Communities (CCRCs).

CCaH is something of a hybrid, contract-based product, sort of a combination of “home care agency” and “long-term care insurance.” The customer makes a prepayment for access to specific services, to be provided in the customer's own home,  The services offered tend to emphasize care coordination; several different types of plans may be offered by a single provider.

From the providers I've reviewed, CCaH contracts typically have an upfront “entry” or membership fee, plus monthly service fees.  In some of the plans there is also cost sharing and deductibles for services.  Overall, the fees, as one would expect, are lower than for traditional CCRCs, but can still be significant.

For example, in a recent report I reviewed, one operation described a series of contracts available.  One contract involved a 90% "refundable" entry fee plan.  In 2012,  a prospective member who qualified at age 88 could expect to pay an entry fee of $147,160, plus monthly service fees ranging from $290 to $584.

In some instances, the company may charge annual fees, rather than a single entry fee plus monthly fees. For example, another Pennsylvania CCaH provider offers "life care plans," "home care plans," and "traditional life care plans."  The first two contracts have annual fees, while the third, "traditional life care plan," is structured with a single upfront entry fee, plus monthly fees of 1% of the entrance fee. 

At that company, for the "life care plan" with annual fees,  a prospective member could select a "life time benefit" of between 1 and 7 years, plus a maximum daily benefit of between $75 per day to $250 per day, with options for a waiting period, cost of living adjustments, and "shared care."  As of April 2016, if a prospective member at age 80 chose a life care plan with a 7 year "maximum life time benefit," no waiting period, no cost of living adjustment and no shared care, he or she could expect to pay annual fees of around $7,880 for a $100 per day benefit -- or up to $15,60o per year for a $200 per day benefit.   Fees would be discounted by 20% for two or more people per household and the benefits and annual fee "may vary based on the member's health status at time of enrollment."  Further, the provider cautions, "though not anticipated, the annual fee for members of life care and home care plans may be adjusted after the fifth anniversary of their continuing care agreement," and any such adjustments would be on a uniform basis for all members in a specific plan.  

In Pennsylvania, all of the current providers of CCaH are connected to or developed by operators of brick and mortar CCRCs, and therefore the CCaH contracts sometimes offer priority admission to the related CCRC if resident care is desired.  I don't think this connection between a CCaH program and a CCRC facility is necessarily required in other states. 

Traditional long-term care insurance has had a troubled history nationally and in Pennsylvania, CCaH providers seem to avoid that history by staying closely tied to the positive reputation of a visible, attractive brick and mortar CCRC.  However, CCaH contracts do not necessarily promise to use the staff or services from the related CCRC, and if so, the CCaH provider may turn to third parties, such as home care agencies, in the search for workers.  The contract terms are key and require careful reading.

Pennsylvania currently licenses five CCaH providers.  The longest operating provider is Friends Life Care at Home, a not-for-profit operation in southeastern Pennsylvania.   It was organized in 1985 and according to registration information at the Pennsylvania Department of Insurance it has approximately 2,500 contracts in existence.   Friends Life Care recently entered into a joint marketing agreement with SpiritTrust Lutheran Life

Continue reading

May 23, 2018 in Consumer Information, Current Affairs, Health Care/Long Term Care, State Cases, State Statutes/Regulations, Statistics | Permalink | Comments (0)

Tuesday, May 22, 2018

Congrats to NAELA

NAELA celebrated its 30th year with its annual conference in New Orleans, LA on May 17-19, 2018. The conference consisted of three tracks: legal tech, advocacy and public benefits.  The well-attended conference packed in a great amount of programming in two and a half days. Speakers included leaders from the field of elder law, consultants, cyber security experts, researchers and more.  NAELA members unable to attend may check the NAELA website for more information.

In addition, Michael Amoruso was sworn in as the next NAELA president by outgoing president Hy Darling.  Congrats NAELA!

(In the interest of full disclosure, I'm a former president of NAELA and co-chair of the planning committee for this conference.)

 

May 22, 2018 in Consumer Information, Current Affairs, Federal Statutes/Regulations, Health Care/Long Term Care, Legal Practice/Practice Management, Medicaid, Medicare, Programs/CLEs, Property Management, Social Security, State Cases, State Statutes/Regulations | Permalink | Comments (0)